Goniometry and linear assessments to monitor movement outcomes: are they reliable tools in burn survivors?
BACKGROUND
Despite common use and theoretical construct validity, goniometry is not reported to be reliable for the measurement of burn-affected joint range of motion. Similarly, a number of simple objective measures commonly used to document hand mobility have eluded this rigour. This study aimed to examine the within sessions of intra-rater and inter-rater reliability of active joint range of motion measurement in patients with burns.


METHODS
Intra-rater reliability: One physical therapist (PT) recorded duplicate measurements on each burn-affected joint after a 5-min interval in a subset of patients (n=21). Inter-rater reliability: Four qualified PTs took part in repeated measures testing of 45 patients on the same day.


RESULTS
Intra-rater reliability was excellent with intraclass correlation coefficients (ICCs>.99) and 95% confidence intervals (CIs)=.99-1.0. Inter-rater reliability was also excellent with ICCs>.94 (95% CIs=.90-.99). The minimum detectable change using goniometry at the ankle was > or =5 degrees and for all other joints tested was > or =9 degrees. For linear hand measures a change of >1cm and thumb opposition > or =1/2 of one scale point indicated measurable difference.


CONCLUSIONS
This study demonstrated excellent intra-rater and inter-rater reliability and measurement of clinically relevant change for all measurements when applied with a standardised protocol. Therefore, assessing joint range of motion (ROM) with a goniometer or hand movement with linear or scale measurements can provide accurate, objective measures in the burns population.
Edgar
Dale
D
Western Australian Burns Service, Royal Perth Hospital, University of Western Australia, McComb Foundation of WA, Australia. dale.edgar@health.wa.gov.au
Finlay
Vidya
V
Wu
Andy
A
Wood
Fiona
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D053587:Arthrometry, Articular / Q000379:methods* / Q000639:trends; D001696:Biomechanical Phenomena; D002056:Burns / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult